
<div class="content-wrapper">
    <div class="container">
        <div class="row pad-botm">
            <div class="col-md-12">
                <h4 class="header-line">Register To FCPAA</h4>
            </div>
        </div>

        <div class="row">

            <div class="col-md-2 col-sm-4 col-xs-6">
                <div class="alert alert-warning back-widget-set text-center alert-zs">
                    <i class="fa fa-arrow-right fa-5x"></i>
                    <h3>Information</h3>
                </div>
            </div>
            <div class="col-md-2 col-sm-4 col-xs-6">
                <div class="alert alert-warning back-widget-set text-center alert-zs">
                    <i class="fa fa-arrow-right fa-5x"></i>
                    <h3>Packages</h3>
                </div>
            </div>
            <div class="col-md-2 col-sm-4 col-xs-6">
                <div class="alert alert-info back-widget-set text-center alert-zs">
                    <i class="fa fa-arrow-right fa-5x"></i>
                    <h3>Addresses</h3>
                </div>
            </div>
            <div class="col-md-2 col-sm-4 col-xs-6">
                <div class="alert alert-warning back-widget-set text-center alert-zs">
                    <i class="fa fa-arrow-right fa-5x"></i>
                    <h3>Statement</h3>
                </div>
            </div>
            <div class="col-md-2 col-sm-4 col-xs-6">
                <div class="alert alert-warning back-widget-set text-center alert-zs">
                    <i class="fa fa-arrow-right fa-5x"></i>
                    <h3>Login</h3>
                </div>
            </div>

        </div>       

        <div class="row">

            <div class="col-md-12">
                <div class="panel panel-info panel-zs">
                    <div class="panel-heading">
                        Mailing Address
                    </div>
                    <div class="panel-body">
                        <form role="form" id="reg3_form">
                            <input type="hidden" name="page" value="reg3">
                            <div class="form-group">
                                <label>Mailing Address line 1</label>
                                <input class="form-control" name="addr1" type="text" />
                            </div>
                            <div class="form-group">
                                <label>Mailing Address line 2</label>
                                <input class="form-control" name="addr2" type="text" />
                            </div>
                            <div class="form-group">
                                <label>Mailing Address line 3</label>
                                <input class="form-control" name="addr3" type="text" />
                            </div>
                            <div class="form-group">
                                <label>City</label>
                                <input class="form-control" name="city" type="text" />
                            </div>
                            <div class="form-group">
                                <label>Postcode</label>
                                <input class="form-control" name="postalcode" type="text" />
                            </div>
                            <div class="form-group">
                                <label>Province</label>
                                <input class="form-control" name="province" type="text" />
                            </div>
                            <div class="form-group">
                                <label>Country</label>
                                <input class="form-control" name="country" type="text" />
                            </div>
                            

                            <button type="button" class="btn btn-info" id="reg3">Next</button>
                            <a href="javascript:history.go(-1);" type="button" class="btn btn-default">Back</a>

                        </form>
                    </div>
                </div>
            </div>
        </div>
        <!--/.ROW-->    


    </div>
</div>
